Brandon, Florida, United States
⦁ Inbound Process and maintain member enrollment and eligibility records impacting claims processing, billing accuracy, and coverage determinations. ⦁ Verify and update eligibility information to support accurate and timely claims adjudication. ⦁ Retain members through proactive outreach, issue resolution, grievance & appeals, while also giving a clear explanation of healthcare benefits and coverage. ⦁ Ensure strict compliance with HIPAA and insurance regulations when managing confidential member data.
• Understand the application of benefits, COB, Fee schedules, and CMS to provide accurate pricing on claims. • Managed high-volume caseloads 70cph, prioritizing tasks to ensure timely completion of all claims with a focus on high-dollar claims. • Maintained compliance with industry regulations and company policies while managing sensitive client information and claims records. • Conducted root cause analyses to identify underlying issues and provide actionable recommendations for resolution.
• Understand the application of benefits, COB, Fee schedules, and CMS to provide accurate pricing on claims. • Managed high-volume caseloads 70cph, prioritizing tasks to ensure timely completion of all claims with a focus on high-dollar claims. • Maintained compliance with industry regulations and company policies while managing sensitive client information and claims records. • Conducted root cause analyses to identify underlying issues and provide actionable recommendations for resolution.
• Understand the application of benefits, COB, Fee schedules, and CMS to provide accurate pricing on claims. • Managed high-volume caseloads 70cph, prioritizing tasks to ensure timely completion of all claims with a focus on high-dollar claims. • Maintained compliance with industry regulations and company policies while managing sensitive client information and claims records. • Conducted root cause analyses to identify underlying issues and provide actionable recommendations for resolution.
• Understand the application of benefits, COB, Fee schedules, and CMS to provide accurate pricing on claims. • Managed high-volume caseloads 70cph, prioritizing tasks to ensure timely completion of all claims with a focus on high-dollar claims. • Maintained compliance with industry regulations and company policies while managing sensitive client information and claims records. • Conducted root cause analyses to identify underlying issues and provide actionable recommendations for resolution.